Practice setting and secondary prevention of coronary artery disease

Abstract

IntroductionPatients with established coronary artery disease (CAD) are at high risk of recurrent cardiovascular events. The aim of the analysis was to compare time trends in the extent to which cardiovascular prevention guidelines have been implemented by primary care physicians and specialists.Material and methodsFive hospitals with cardiology departments serving the city and surrounding districts in the southern part of Poland participated in the study. Consecutive patients hospitalized due to an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6–18 months after hospitalization. The surveys were carried out in 1997–1998, 1999–2000, 2006–2007 and 2011–2013.ResultsThe proportion of smokers increased from 16.0% in 1997–1998 to 16.4% in 2011–2013 among those who declared that a cardiologist in a hospital outpatient clinic decided about the treatment, from 17.5% to 34.0% (p < 0.01) among those treated by a primary care physician, and from 7.0% to 19.7% (p = 0.06) among patients treated in private cardiology practices. The corresponding proportions were 44.6% and 42.4% (p < 0.01), 47.7% and 52.8% (p = 0.53), 44.2% and 42.2% (p = 0.75) for high blood pressure, and 42.5% and 71.2% (p < 0.001), 51.4% and 79.6% (p < 0.001), 52.4% and 72.4% (p < 0.01) for LDL cholesterol level not at recommended goal. The proportion of patients prescribed cardioprotective medications increased in every analyzed group.ConclusionsThe control of cardiovascular risk in CAD patients has only slightly improved since 1997/98 in all health care settings. The greatest potential for further improvement was found among patients whose post-hospital care is provided by primary care physicians. It is associated with promotion of a no-smoking policy and enhanced prescription of guideline-recommended drugs.

Managed Care after Acute Myocardial Infarction (KOS-zawał) reduces major adverse cardiovascular events by 45% in 3-month follow-up – single-center results of Poland’s National Health Fund program of comprehensive post-myocardial infarction care

“…This is similar to data reported from the USA and European countries [2][3][4]. The studies suggest that efforts should focus on post-MI care and secondary prevention of CVD [5][6][7].…”

Comparison of low-density lipoprotein cholesterol level calculated using the modified Martin/Hopkins estimation or the Friedewald formula with direct homogeneous assay measured low-density lipoprotein cholesterol

“…Accurate LDL-C estimation is crucial to ensure patients are meeting their risk-stratified goals on Table II. Mean levels of MH-LDL-C, F-LDL-C and Di-LDL-C if MH-LDL-C, F-LDL-C and Di-LDL-C below 1.8 mmol/l depending on TG ranges TG MH-LDL-C < 1.8 F-LDL-C < 1.8 Di-LDL-C < 1.8 lipid-lowering therapy [22][23][24][25] and for more accurate discrimination among dyslipidemia phenotypes [26]. If not, then significant "hidden" residual risk remains.…”

PoLA/CFPiP/PCS Guidelines for the Management of Dyslipidaemias for Family Physicians 2016

“…In 71.9%, 38.6%, 24.4% and 10.3% of the subjects, however, LDL-C concentrations were ≥ 70 mg/dl (≥ 1.8 mmol/l), ≥ 100 mg/dl (≥ 2.5 mmol/l), ≥ 115 mg/dl (≥ 3.0 mmol/l) and ≥ 160 mg/dl (≥ 4.0 mmol/l), respectively [21]. Studies conducted over the past 20 years suggest that the success rate in achieving the recommended LDL-C level in patients with IHD has not changed in relation to the end of the 20 th century [22]. The success rate in achieving target LCL-C levels in patients who are treated in primary care does not deviate significantly from the success rate in patients declaring that their treatment is prescribed by physicians in specialist cardiac outpatient clinics [22].…”